The relationship between alexithymia and self-harm: The mediating role of mindfulness

Self-harm, defined as any act of self-injury, irrespective of motivation, is a phenomenon which can have serious consequences for the individual, as well as significant public health costs. Many correlational studies have established a significant association between self-harm and alexithymia, a cognitive deficit in emotion processing, characterised by a difficulty identifying and describing feelings and an externally orientated thinking style. The current study investigated whether this relationship is explained by low levels of dispositional mindfulness. An opportunity sample of 325 community-based adults completed an online survey measuring their history of self-harm, alexithymia (Toronto Alexithymia Scale) and mindfulness (Five Facets of Mindfulness Questionnaire). Alexithymia was significantly higher among participants with a history of self-harm, compared with participants with no history of self-harm. All mindfulness facets were significantly lower among participants with a history of self-harm except the facet Observe which was significantly higher in that group. A multiple mediation analysis found that the mindfulness facets Non-judge and Non-react were positive, significant mediators of the relationship between alexithymia and self-harm, but the facet Observe suppressed the relationship. The relationship between alexithymia and self-harm can be explained in part by deficits in mindfulness skills, particularly the ability to accept emotional experience without judgment or reaction. Conversely, the external orientation of alexithymia may itself be protective against self-harm, through the avoidance of excessive introspection. Thus, merely learning to observe inner experience, without the ability to understand and accept that experience, may have adverse consequences.